Objectives To comprehensively analyse the disease presentation and mortality of COVID-associated rhino-orbito-cerebral mucormycosis. Methods A retrospective analysis of the demographics, clinical and radiographic findings was performed. A binary logistic regression analysis was performed to examine the survival of patients with mucormycosis from hypothesised predictors. Results A total of 202 patients were included in this study. Statistical significance was demonstrated in the predilection to the male gender, recent history of SARS-COV-2, history of use of corticosteroid and hyperglycemia in this cohort of CAM. The mortality rate was 18.31%. Advanced age, raised HbA1c and intra-orbital extension were found to be predictors adversely affecting survival. Conclusion Early diagnosis, aggressive surgical therapy, early and appropriate medical therapy can help improve outcomes. Level of evidence Level 4.

Introduction: New challenges in dialysis care delivery confront caregivers with the rise in dialysis numbers. There are significant lacunae in the knowledge and efficient application of dialysis therapy in the absence of a dialysis registry. This multicentric study was conducted by the Nephrology Association of Karnataka to systematically study patient demographics and dialysis characteristics in Karnataka state, India, as a basis for a statewide dialysis registry. Material and Methods: Data were collected from the consenting dialysis centers after institutional ethics board clearances. Residents of Karnataka state, who were confirmed prevalent patients with end-stage renal disease, on either maintenance hemodialysis (HD) or peritoneal dialysis were included. Demographic data of patients and details of dialysis as well as dialysis facilities were collected on an online platform. Statistical analysis was done using SPSS software Version 16. Results: Thirty-two centers contributed to the data of 2,050 patients (males 70.3%, mean age 53.49 ± 14.09 years). Most patients were on HD (95.3%). Diabetes was the commonest cause of chronic kidney disease. About 72% of patients had temporary venous catheters as initial vascular access. In all, 1,156 patients (59.9%) were on thrice weekly HD. Around 65% of the centers were in private hospitals. The majority (90%) of the centers reused dialyzers, 56% reprocessed dialyzers mechanically, and 66% tested viral serology quarterly. Conclusions: This study was one of the initial attempts to capture dialysis data across Karnataka, and it offers useful insight into the existing dialysis demographics and care delivery. Participation of more centers and continued effort to form a dialysis registry for deriving meaningful clinico-epidemiological insight are desirable.

Nifedipine is a classical dihydropyridine calcium channel blocker (CCB) indicated for the management of hypertension, vasospastic angina and chronic stable angina. Prestigious regulatory bodies like USFDA, EMA, CDSCO and TGA have approved long-acting Nifedipine for the management of hypertension and angina. Nifedipine was 1st introduced in United States as Adalat® (Bayer) in 1981 and in India as Nicardia® (J. B. Chemicals & Pharmaceuticals) in 1985. Conventional Nifedipine shows the rapid onset and short duration of action which results in prompt and marked hypotensive effect but exhibits reflex SNS activation leading to flushing, tachycardia, worsening myocardial ischemia, and cerebrovascular ischemia. Nifedipine gastrointestinal therapeutic system (GITS) formulation addresses many of the concerns surrounding the older formulations of Nifedipine. Nifedipine GITS is a gold standard once-daily formulation of Nifedipine which allows relatively constant plasma drug concentrations over 24 hours. Nifedipine GITS provides a controlled release and gradual onset of action of Nifedipine, avoiding the reflex SNS activation resulting in improved tolerability and compliance. Clinical studies suggest that long-acting formulations of Nifedipine have slightly greater antihypertensive actions than Amlodipine. Nifedipine was also found to be more efficient than other CCBs like Amlodipine, Nicardipine, and Isradipine in resistant hypertensive patients. The addition of Nifedipine GITS to the conventional treatment of angina pectoris is safe and reduces the need for coronary angiography and interventions. Several landmark trials have demonstrated that long-acting Nifedipine improves endothelial function and arterial stiffness and reduces albuminuria, LV hypertrophy, atherosclerotic plaques and cardiovascular and cerebrovascular complications. This comprehensive review focuses on the superiority of the Nifedipine GITS formulation over the conventional Nifedipine and elaborates on the role of long-acting Nifedipine as a CCB of choice for the management of hypertension, resistant hypertension, angina pectoris and coronary artery disease. Keywords – Calcium Channel Blockers, Nifedipine, Long-Acting Nifedipine, Nifedipine GITS, Nifedipine Extended Release, Nicardia XL.

The coronavirus disease 2019 (COVID-19) pandemic forced a dramatic reduction in international travel and had a significant impact on the conduct of medical conferences. After cancelling the World Congress of Nephrology (WCN) 2020, the ISN hosted WCN 2021 (WCN21) for the first time on a virtual platform. We reflect on the several challenges and opportunities of the virtual conference and consider the complementary role of social media (SoMe) coverage in the conference. The ISN conducted the virtual WCN21 from April 15, 2021 to 19, 2021. The virtual platform for the conference was chosen after a careful review to support aspects of the original in-person format, such as precongress courses, plenary sessions, symposia, oral research presentations, and late-breaking clinical trials, including virtual e-poster sessions, industry exhibitions, and networking areas. The portal worked well on both the desktop and the mobile platforms for ease of access. Besides the obvious advantages of virtual WCN21, such as delegate safety, reduced travel expenditure, time, and carbon footprint,1Rundle C.W. Husayn S.S. Dellavalle R.P. Orchestrating a virtual conference amidst the COVID-19 pandemic.Dermatol Online J. 2020; 26 (13030/qt5h19t1jx)Crossref Google Scholar,2Sarabipour S. Khan A. Seah Y.F.S. et al.Changing scientific meetings for the better.Nat Hum Behav. 2021; 5: 296-300https://doi.org/10.1038/s41562-021-01067-yCrossref PubMed Scopus (15) Google Scholar wider accessibility, and convenience of access, it allowed for the inclusion of many speakers (n = 241) from a large number of countries (n = 45) despite a lesser number of sessions (n = 86 in WCN21 vs. 158 in WCN 2019). WCN21 also had more delegates compared with WCN 2019 (n = 3918 vs. 3580 participants) with a 29% increase in the participating countries (n = 139 vs. 107), from a wider range of regions and time zones. Geographic distribution of participants in WCN21 Canada versus WCN 2019 Australia was as follows, respectively: Western Pacific 22% versus 61%; North and Central America 22% versus 11%; Europe 19% versus 11%, and other regions such as South Asia, South East Asia, North Asia, South America & Caribbean, and Middle East 32% versus <9% (Figure 1). The wider reach of the virtual WCN21 extending to lower-income regions supported the commitment of ISN to equitable access. The challenges of the virtual conference included limited discussions and collaborations, reduction in interactions and engagement, lack of undivided attention, time zone limitations on global live participation, and loss of conference revenue to the professional society. Availability of conference sessions on the online ISN Academy platform for future viewing by registered attendees of different time zones, at their convenience, was useful. The additional novel content including time zone-specific “Raising-The-Curtain” sessions, poster talks, podcasts, visual abstracts (VAs), online quizzes, and comprehensive SoMe coverage by the WCN21 SoMe team complemented the conference and sought to offset some challenges. The @ISNeducation SoMe Team, an integral component of the ISN Education Working Group,3Desai T. Conjeevaram A. Taco O. et al.The birth [email protected]Kidney Int. 2017; 92: 1024-1028https://doi.org/10.1016/j.kint.2017.07.014Abstract Full Text Full Text PDF PubMed Scopus (5) Google Scholar provides comprehensive coverage of congress lectures and presentations since 2017. WCN21 was widely covered in SoMe platforms, including Twitter, Facebook, Instagram, and LinkedIn, and shared by YouTube and WhatsApp that provided an alternate avenue for user engagement. Despite the perception that the virtual nature of the conference may reduce its relevance, SoMe coverage of WCN21 sought to enhance the conference content with several strategies. The SoMe coverage on Twitter is measured variably with the number of tweets and impressions and engagements. Impressions on Twitter are the cumulative number of times the post has been seen—including the number of times it appears in the timeline of followers, or the search, or as a result of someone “liking” the Tweet. Besides impressions, engagement metrics, such as the number of “likes,” retweets, clicks to expand or view the media content or links, and replies to the tweet, provides more meaningful metrics of reach. During the precongress and congress period (April 12, 2021–19, 2021) WCN21 received >13,000 tweets, with 75% carrying media content, accruing a total of 27.8 million impressions. The daily average was 2300 tweets and 4.9 million impressions with 2900 tweets/d at its peak. Mobile phones were predominant devices for Twitter access (69%). Despite having 54% lesser sessions in WCN21 (n = 86 vs. 158 WCN 2019), there was a robust SoMe engagement, with >77% retweets and 7.6% receiving replies (Figure 2). Most users (77%) participated with 1 to 3 tweets with 12% composing ≥10 tweets. The low rate of replies could be attributed to the virtual nature of the conference competing for attention and interaction. Redesigning SoMe coverage with interactive content use such as quizzes, debates, and open questions seeking opinions could help improve engagement. As the virtual conference activities occurred mostly at 4:30 PM to 8:30 PM Eastern Daylight Time, most WCN21 Twitter users were from compatible time zones of North America, the United Kingdom, and India. The Twitter engagement was the least from Africa, led by users from Nigeria and Egypt. A total of 15 precongress interviews with selected speakers of WCN21 were conducted from 8 to 3 weeks before the conference and released as video snippets through the ISN Youtube channel. Shared by SoMe, the interviews garnered 114,596 impressions, 9371 media views on Twitter; 3175 impressions, 1587 media views on LinkedIn; 2397 reaches, 740 video views on Instagram, and 6501 views on Facebook. The mean duration of the interviews was 9:20 (3:43–21:16) minutes, whereas the viewer attention span lasted only 3:41 minutes. For optimal future use of this modality, shortening the duration and re-engaging users at 3 minutes would be useful. Raising-the-curtain sessions, organized in collaboration with ISN collective member societies of the 6 regional boards of ISN (Oceania and South Asia, North and East Asia, East and Central Europe, Western Europe, Africa, and Latin America), to discuss common global challenges and region-specific issues were scheduled at the beginning of the WCN21 with free-of-charge preregistration. These sessions popularized WCN21 and engaged the global nephrology audience. The most viewed session was by the Pakistan Society of Nephrology and the Nepalese Society of Nephrology, discussing challenges in transplantation and dialysis in the South Asia region. There were 890 abstracts submitted to the virtual WCN21. Selected posters were chosen for “poster talks,” an audiovisual description of the poster content, simulating a live presentation. The poster talks were shared widely on SoMe platforms. The most accessed poster talk was on “The revised KDIGO clinical practice guidelines on glomerular diseases part-2.” As in WCN 2019,4Anandh U. Basu G. Bajpai D. et al.Social media coverage of the International Society of Nephrology World Congress of Nephrology 2019: exploring novel strategies.Kidney Int Rep. 2020; 5: 1615-1619https://doi.org/10.1016/j.ekir.2020.07.038Abstract Full Text Full Text PDF PubMed Scopus (1) Google Scholar selected posters were made into VAs, readily shareable through SoMe. WCN21 featured 27 precreated VAs (made before the conference) and 2 live VAs (made in real-time during the session), published on the congress platform and Twitter, garnering a total of 52,348 impressions, 270 retweets, and 2365 total engagements (average of 1805 impressions, 81.5 engagements, and a median of 60 likes per tweet). The live VAs generated more impressions (3417 vs. 1686) and engagements (181 vs. 74) compared with precreated VAs. The most accessed VA was on “The Changing Dynamics of Nephrology Online Education in 2020” (https://twitter.com/ISNWCN/status/1383124875926069248?s=20) (precreated VA with 271 engagements, 34 likes, 68 expanded views, and 21 retweets). Tweets with the scientific content of WCN21 were packaged into short interactive online quizzes on the https://outgrow.co/ platform and released at the end of each day of the congress. Each quiz was designed as an untimed activity of 10 multiple-choice questions with supporting infographics, VAs or pictures, and links to the original tweet/reference article. At the end of the quiz, the participants received an answer key with links to the original tweet and/or research article, detailed feedback on the choices, a personal score, and a global rank in real-time. Quizzes were shared with a clickable link on SoMe, and winners were acknowledged on SoMe with e-certificates. Overall, 4 quizzes covering each day of WCN21 received 2275 page visits and 1253 completed attempts by July 28, 2021 (Table 1). Although 57% of quiz attempts (713 of 1253) were on April 19, 2021, there was ongoing global participation for long after the congress. Furthermore, although 63.3% (range on the 4 days—58.1%–69.2%) of the participants completed the quiz on mobile phones, emphasizing the ease of accessibility, 35.4% (29.2%–40.7%) used laptops/desktops and 1.3% accessed it on tablets. All the quizzes are permanently archived in the ISN Academy as an accessible long-term educational resource.Table 1Data of the 4 quizzes during WCN 2021 (as of July 28, 2021)ParametersQuiz 1Quiz 2Quiz 3Quiz 4Page visits (n = 2755)765516424570Completed quiz attempts (n = 1253403290245315Completed quiz attempts after conference days (n = 713)243150119201Score (median, interquartile range) maximum score = 102 (0–5)3 (1–6)5 (1–7)3 (1–5)WCN, World Congress of Nephrology. Open table in a new tab WCN, World Congress of Nephrology. WCN21 quizzes gathered 5 times higher responses as compared with those at WCN 2019 (in-person congress),3Desai T. Conjeevaram A. Taco O. et al.The birth [email protected]Kidney Int. 2017; 92: 1024-1028https://doi.org/10.1016/j.kint.2017.07.014Abstract Full Text Full Text PDF PubMed Scopus (5) Google Scholar underlining its popularity in a virtual congress. Being an interactive, gamified educational review of selected conference content that is free of charge, unrestricted by geography and time, the quizzes became a popular resource facilitating active learning during and beyond the congress. As part of the Global Kidney Care Podcast Series, WCN21 used daily podcasts on interviews and interesting topics to disseminate conference information and better engage the audience. The podcasts provide a more nuanced discussion on several aspects of the topic, where short tweets or tweetorials are unlikely to do justice. There were 6 podcast sessions wıth multiprong discussions among presenters from across the globe that were released daily during the conference. The podcasts were downloaded 797 times, with an average of 132 downloads per episode. The most downloaded podcast (211 downloads) covered peritoneal dialysis, acute kidney injury, and regional capacity building. The pandemic had imposed unique challenges in the format of medical conferences, enforcing a move from the physical, face-to-face meetings to an online virtual format. The strategies proposed for successful conducting virtual meetings include preplanning, testing of different platforms, use of readily and widely available technology, offering real-time responses, communication options to engage the audience, and postmeet evaluation.5Rubinger L. Gazendam A. Ekhtiari S. et al.Maximizing virtual meetings and conferences: a review of best practices.Int Orthop. 2020; 44: 1461-1466https://doi.org/10.1007/s00264-020-04615-9Crossref PubMed Scopus (48) Google Scholar,6Fulcher M.R. Bolton M.L. Millican M.D. et al.Broadening participation in scientific conferences during the era of social distancing.Trends Microbiol. 2020; 28: 949-952https://doi.org/10.1016/j.tim.2020.08.004Abstract Full Text Full Text PDF PubMed Scopus (12) Google Scholar WCN21 used these strategies effectively, allowing for limited real-time audience-speaker interaction and networking opportunities with break-out sessions. The real-time WCN21 SoMe coverage supported by the adoption of poster talks, VA, quizzes, and podcasts amplified its reach to a broader audience. The future beckons a hybrid meeting format, where some participants join online while others attend in-person, to enjoy the benefits of both formats.7Woodruff P. Wallis C.J.D. Albers P. Klaassen Z. Virtual Conferences and the COVID-19 pandemic: are we missing out with the online-only platform?.Eur Urol. 2021; 80: 127-128https://doi.org/10.1016/j.eururo.2021.03.019Abstract Full Text Full Text PDF PubMed Scopus (3) Google Scholar,8Athitakis M. The rise of the hybrid meeting. Associations Now.https://associationsnow.com/2020/11/the-rise-of-the-hybrid-meeting/Google Scholar A hybrid meeting format will bring unique challenges for the organizers, including staffing, scheduling, pricing, session preparation, and balancing participant engagement with online facilitation. Moderators, speakers, and presenters need different styles and skillsets for simultaneously managing the in-person and the virtual formats. Tech-savvy speakers/moderators with good SoMe following and experience provide a particular advantage, by enhancing the online networking of the hybrid meeting. The pandemic-fueled change in the conference format along with the innovative support by the @ISNeducation team is promising and raises the expectations for the hybrid WCN 2022.

In Situation Report #13 and 39 days before declaring COVID-19 a pandemic, the WHO declared a COVID-19 infodemic. The volume of coronavirus tweets was far too great for one to find accurate or reliable information. Healthcare workers were flooded with noise which drowned the signal of valuable COVID-19 information. To combat the infodemic, physicians created healthcare-specific micro-communities to share scientific information with other providers. We analyzed the content of eight physician-created communities and categorized each message in one of five domains. We coded 1) an application programming interface to download tweets and their metadata in JavaScript Object Notation and 2) a reading algorithm using visual basic application in Excel to categorize the content. We superimposed the publication date of each tweet into a timeline of key pandemic events. Finally, we created NephTwitterArchive.com to help healthcare workers find COVID-19-related signal tweets when treating patients. We collected 21071 tweets from the eight hashtags studied. Only 9051 tweets were considered signal: tweets categorized into both a domain and subdomain. There was a trend towards fewer signal tweets as the pandemic progressed, with a daily median of 22% (IQR 0-42%). The most popular subdomain in Prevention was PPE (2448 signal tweets). In Therapeutics, Hydroxychloroquine/chloroquine wwo Azithromycin and Mechanical Ventilation were the most popular subdomains. During the active Infodemic phase (Days 0 to 49), a total of 2021 searches were completed in NephTwitterArchive.com, which was a 26% increase from the same time period before the pandemic was declared (Days -50 to -1). The COVID-19 Infodemic indicates that future endeavors must be undertaken to eliminate noise and elevate signal in all aspects of scientific discourse on Twitter. In the absence of any algorithm-based strategy, healthcare providers will be left with the nearly impossible task of manually finding high-quality tweets from amongst a tidal wave of noise.

Abstract Background and Aims Evaluation of Health-related quality of life (HRQoL) is an important, albiet neglected component of health care in patients with End Stage Renal Disease (ESRD). RAND-36 is a validated scoring system for evaluating HRQoL. Patients on hemodialysis experience decrease in various aspects of HRQoL. Various disease related and socio-economic factors influence HRQoL. There is limited data on HRQoL among patients of ESRD on hemodialysis from Indian subcontinent. In the present study, we aim to evaluate the HRQoL using RAND-36 score & the factors which influence it’s various aspects. In addition, we aim to evaluate patient perception of ease of access to dialysis related health care and its impact on RAND-36 score. Method This cross sectional, multi-centric study was performed in Nov 2020. A random sampling was employed to select the study participants. Patients with history of psychiatric illness, significant impairment of hearing, speech, or cognitive disturbances were excluded. RAND 36-Item Health Survey (Version 1.0) was used and circulated amongst dialysis patients across 10 dialysis centres in hospitals across India. Final scores were calculated using standard guidelines. A proprietary software from Bloom Value Corporation was used for data capture by electronic means and Power BI was used for analysis. Results 257 ESRD patients on hemodialysis completed the survey. Mean age was 52.9 years. 65.4 % participants were males, 39.69% were Diabetics and 75.88% had hypertension. Accessibility to healthcare was reported by 36% and 27.7% patients as ‘excellent‘ and ‘very good’ respectively. The mean scores in various scales were Physical Functioning (PF) 47.27±27.87 %, Role limitations due to physical health (RP) 54.18 ± 40.97 % , Role limitations due to emotional problems (RE) 55.38 ± 43.57 %, Energy/fatigue (EF) 49.80 ± 19.38 %, Emotional wellbeing (EW) 57.71 ± 22.04 %, Social functioning (SF) 58.02 ± 25.32%, Pain (BP) 68.28 ± 23.52 % and General Health (GH) 48.11 ±16.43%. Lower PF Scores were seen with higher age (NS), ≥ 2 comorbidities (NS). PF scores were higher in patients with Government insurance and higher perception of healthcare accessibility (NS). RP Scores were higher in males and with advancing age (NS). Employed patients had lower RP scores (p=0.009). RE scores were lower in patients with ≥ 2 comorbidities (NS) and among Employed patients (p=0.04). EF Scores were higher in males (p=0.07) and lower in patients with ≥ 2 comorbidities (NS). EW scores were higher in males (p=0.09) and among patients with higher perception of healthcare accessibility (NS). SF Scores were higher in males (p=0.08) and with higher perception of healthcare accessibility (NS). BP Scores were higher among patients with≥ 2 comorbidities (p=0.04) and higher perception of healthcare accessibility (NS). GH scores were higher with Government Insurance availability and higher perception of healthcare accessibility (NS). Conclusion To our knowledge this is the first multi-centric study conducted amongst ESRD patients in India, evaluating HRQoL using RAND36 scores. There is significant heterogeneity in patient reported outcomes and it’s determinants. Government Insurance support and a higher perception of healthcare availability have positive impact on many aspects of HRQoL. This is a valuable tool in executing patient centred care.

Background: The coronavirus disease-2019 (COVID-19) pandemic has disrupted health-care delivery globally. Patients on in-center hemodialysis (HD) are particularly affected due to their multiple hospital visits and the need for uninterrupted care for their well-being and survival. We studied the impact of the pandemic and the national policy for pandemic control on the HD care delivery in Karnataka state in India in April 2020, when the first and second national lockdown were in place. Materials and Methods: An online, questionnaire-based survey of dialysis facilities was conducted, and the responses analyzed. The questions were pertaining to the key areas such as changes in a number of dialysis treatments, frequency, duration, expenses, transportation to and from dialysis units, impact on the availability of consumables, the effect on dialysis personnel, and on machine maintenance. Results: Sixty-two centers participated. Median of dialysis treatments for the months of March and April 2020 was 695.5 and 650, respectively. Reduction in dialysis treatments was noted in 29 (46.8%) facilities, decreased frequency reported by sixty centers. In at least 35 (56.5%) centers, dialysis patients had to bear increased expenses. Cost and availability of dialysis consumables were affected in 40 (64.5%) and 55 (88.7%) centers, respectively. Problems with transportation and movement restriction were the two key factors affecting both patients and dialysis facilities. Conclusions: This survey documents the collateral impact of COVID-19 on the vulnerable group of patients on HD, even when not affected by COVID. It identifies the key areas of challenges faced by the patients and the facilities and implores the care providers for finding newer avenues for mitigation of the problems.

Increasing demand for organ transplantation which is often the lifesaving treatment for organ failure and a shortage of organs is a crisis prevalent in many countries. Proactive engagement of the society by improving awareness about organ donation is perceived to be the key to address the problem of organ shortage. In the current digital era, social media (SoMe) organ donation campaigns are one of the most practical and effective ways to disseminate information and promote collaboration among participants. Many governmental and nongovernmental organizations and social activists are utilizing popular SoMe platforms such as Facebook, Twitter, YouTube, and Instagram to promote organ donation awareness. Although such SoMe campaigns are impactful and open unique possibilities to address organ shortage, one should also be aware of the challenges of maintaining confidentiality, the potential for misuse, misinformation, and negative framing. In this narrative review, we review the use of SoMe to promote organ donation including its benefits, pitfalls, and attempt to list some recommendations.

In Situation Report #13 and 39 days before declaring COVID-19 a pandemic, the WHO declared a “COVID-19 infodemic”. The volume of coronavirus tweets was far too great for one to find accurate or reliable information. Healthcare workers were flooded with “noise” which drowned the “signal” of valuable COVID-19 information. To combat the infodemic, physicians created healthcare-specific micro-communities to share scientific information with other providers. Our objective was to eliminate noise and elevate signal tweets related to COVID-19 and provide easy access to the most educational tweets for medical professionals who were searching for information. We analyzed the content of eight physician-created communities and categorized each message in one of five domains. We coded 1) an application programming interface to download tweets and their metadata in JavaScript Object Notation and 2) a reading algorithm using visual basic application in Excel to categorize the content. We superimposed the publication date of each tweet into a timeline of key pandemic events. Finally, we created NephTwitterArchive.com to help healthcare workers find COVID-19-related signal tweets when treating patients. We collected 21071 tweets from the eight hashtags studied. Only 9051 tweets were considered signal: tweets categorized into both a domain and subdomain. There was a trend towards fewer signal tweets as the pandemic progressed, with a daily median of 22% (IQR 0-42%). The most popular subdomain in Prevention was PPE (2448 signal tweets). In Therapeutics, Hydroxychloroquine/chloroquine wwo Azithromycin and Mechanical Ventilation were the most popular subdomains. During the active Infodemic phase (Days 0 to 49), a total of 2021 searches were completed in NephTwitterArchive.com, which was a 26% increase from the same time period before the pandemic was declared (Days -50 to -1). The COVID-19 Infodemic indicates that future endeavors must be undertaken to eliminate noise and elevate signal in all aspects of scientific discourse on Twitter. In the absence of any algorithm-based strategy, healthcare providers will be left with the nearly impossible task of manually finding high-quality tweets from amongst a tidal wave of noise. not applicable

AbstractThe COVID-19 pandemic has disrupted health care delivery globally. Patients on in-centre haemodialysis(HD) are particularly affected due to their multiple hospital visits and the need for uninterrupted care for their well-being and survival. We studied the impact of the pandemic and the national policy for pandemic control on the HD care delivery in Karnataka state in India in April 2020, when the first and second national lockdown were in place. An online, questionnaire based survey of dialysis facilities was conducted and the responses analysed. The questions were pertaining to the key areas such as changes in number of dialysis treatments, frequency, duration, expenses, transportation to and from dialysis units, impact on availability of consumables, effect on dialysis personnel and on machine maintenance. 62 centres participated. Median of dialysis treatments for the months of March and April 2020 were 695.5 and 650 respectively. Reduction in dialysis treatments was noted in 29(46.8%) facilities, decreased frequency reported by 60 centres. In at least 35(56.5%) centres, dialysis patients had to bear increased expenses. Cost and availability of dialysis consumables were affected in 40(64.5%) and 55(88.7%) centres respectively. Problems with transportation and movement restriction were the two key factors affecting both patients and dialysis facilities.This survey documents the collateral impact of COVID-19 on the vulnerable group of patients on HD, even when not affected by COVID. It identifies the key areas of challenges faced by the patients and the facilities and implores the care-providers for finding newer avenues for mitigation of the problems.

For years, traditional endeavours of dissemination of nephrology concepts to a wider audience evolved in many1Rose B.D. Nephrologists Sans Frontieres: how I became a teacher.Kidney Int. 2008; 73: 901-902Abstract Full Text Full Text PDF PubMed Scopus (2) Google Scholar but was often unidirectional, limiting the contributors to a sleect few and reached only a privileged few who could access content behind paywalls and the dissemination of information was restricted. However, social media (#SoMe) is revolutionizing medical education by using technical advancements and evolving pedagogies that emphasize on learners as co-producers of knowledge and bridge formal and informal learning through multidirectional participation of digital communities at a global level with considerable ease and little cost. Over the past decade, pushed by the end-users popularizing conference content in social media, many medical societies have taken to Twitter to popularize the content of their conferences as well as to spread the scientific content.2Allen C.G. Andersen B. Chambers D.A. et al.Twitter use at the 2016 Conference on the Science of Dissemination and Implementation in Health: analyzing #DI Science16.Implement Sci. 2018; 13: 34Crossref PubMed Scopus (11) Google Scholar After initial reluctance, medical societies have allowed unrestricted sharing of presentations and photos, further strengthening the contribution of the end-users in dissemination of knowledge. This has also led to development of various social media tools and resources in nephrology.3Colbert G.B. Topf J. Jhaveri K.D. et al.The social media revolution in nephrology education.Kidney Int Rep. 2018; 3: 519-529Abstract Full Text Full Text PDF PubMed Scopus (40) Google Scholar The International Society of Nephrology (ISN), as a global nephrology society, initiated a trial of social media–based dissemination of nephrology content at the World Congress of Nephrology (WCN) in March 2015 at Cape Town, when not only by general coverage of the conference with the Twitter handle @isnkidneycare and a hashtag of #ISNWCN2015 along with sharing of photographs of conference content, but also live-tweeting and live-streaming select sessions, using the hashtag #WCNLiveStream was conducted (Supplementary Figure S1). Bolstered by this experience, it formalized the ISN social media task force initiative in 2016 (including clear policies on sharing photographs of content presented) to cover WCN 2017 (April 2017) at Mexico City,4Desai T. Conjeevaram A. Taco O. et al.The birth of @ISNeducation.Kidney Int. 2017; 92: 1024-1028Abstract Full Text Full Text PDF PubMed Scopus (4) Google Scholar forming the social media education team, @ISNeducation, and a comprehensive strategy to cover medical conferences like the WCN by the conference-specific @ISNWCN group, which includes members from within and outside the @ISNeducation team to encourage wider participation, inclusiveness, and community engagement. The @ISNeducation team has continued to develop and incorporate several social media education tools, such as visual abstracts, Twitter quizzes, and poster interviews in conference converage. The overall reach and impact of the different tools adopted in social media of the World Congress of Nephrology in 2019 at Melbourne Australia (WCN 2019) are presented here to underline the global significance of this ISN initiative. The WCN2019 held from April 11 to April 15, 2019, at Melbourne, was covered in social media with Twitter as the predominant medium by a total of 39 dedicated educators of the ISN Social Media Team (ISNSoMe team) from across the world both from on-site (n = 17) and remote locations (n = 21). There were a total of 17,507 interacted tweets (# ISNWCN) during the conference by 1904 users from across the globe, at a rate of 123 tweets per hour (from April 11, 2019, 12:00 am to April 17, 2019, 10:59 pm) (Figure 1), with an average of 9.66 tweets per account. Approximately 9% tweeted ≥10 tweets and >25 users tweeted >100 tweets. The data calculated were with the hashtag #ISNWCN. The hashtags #ISNeducation and #visualabstracts were also commonly used in the conference. After English (n = 13,071, 73.6%), Spanish (3445, 19.4%) was the most common language of tweets. Most tweets belonged to the penultimate (n∼8500) and the second day (n∼7000) of the conference. Reaching to 91 countries across all continents, Twitter engagement was robust, with 24.9 million potential impressions, 13,700 retweets, and 7.4% replies (Symplur data analysis). The tweeted content had links to 2500 individual articles and a total of 18,500 visuals, with 66.8% of the total tweets (n = 11,864) carrying media links (66.8%). The highest trending content widely retweeted was the coverage of the late-breaking clinical trial presentation of the CREDENCE (Canagliflozin and Renal Outcomes in Type 2 Diabetes and Nephropathy) trial.5Perkovic V. Jardine M.J. Neal B. et al.for the CREDENCE Trial InvestigatorsCanagliflozin and renal outcomes in Type 2 diabetes and nephropathy.N Engl J Med. 2019; 380: 2295-2306Crossref PubMed Scopus (1553) Google Scholar The simultaneous publication on the last day of the conference had a potential impact on the number of tweets (Supplementary Figure S2). Overall, the educators' emphasis was mostly on lectures and discussions on patient outcomes in clinical areas such as diabetic nephropathy, dialysis, glomerulonephritis, and polycystic kidney disease. Although the Twitter activity and the global reach of the conference were significant (Supplementary Table S1), the quality of the content presented in the tweets were enriched by several strategies adopted by the ISNSoMe team. A visual abstract (VA), introduced in 2017,6Ibrahim A. Lillemoe K. Klingensmith M. Dimick J. Visual abstracts to disseminate research on social media.Ann Surg. 2017; 266: e46-e48Crossref PubMed Scopus (92) Google Scholar is a single concise, pictorial summary providing a snapshot of the central content of the paper/talk without clutter. The ISNSoMe team had adopted this to help disseminate conference content from WCN2019 in 2 ways: precreated and live-created VA. First, VAs were precreated before the conference for preselected, accepted, preconsented oral and poster presentations on a standard WCN2019 themed template, by a subteam of the ISN SoMe team collaborating via e-mail, WhatsApp, and Slack, crosschecked, proofread, and tweeted out to the audience at a time of the presentation at the conference (Supplementary Figure S3). Second, for a few sessions chosen based on the content, interest, and suitability, a team of expert VA editors pioneered the creation of live VAs, constructing them in real time when sessions were in progress and shared across social media. A total of 25 precreated and 5 live VAs were tweeted during the conference. The VA-tweets gained (per VA) a median (minimum, maximum) of 1659 (747, 4214) impressions and 90 (21, 414) engagements (retweets, replies, comments, or profile visits), 12 (4, 43) likes and 8 (2, 25) retweets. Of note, live VA tweets had a trend toward higher impressions and engagement (Table 1).Table 1World Congress of Nephrology 2019 VAs, poster talks, poster interview, Twitter engagement metrics (metrics per tweet)Tweet activityVAsPoster interviewsMean (max, min) n = 25Poster talksMean (max, min) n = 21Live VAMean (max, min) n = 5Precreated VAMean (max, min) n = 25Total VAMean (max, min) n = 30Impressions2132.4 (2760, 1457)1901.1 (3954, 733)1949.3 (3954, 733)1489 (3632, 370)1889.5 (3712, 962)Total engagements255.6 (413, 146)78.6 (167, 21)115.5 (413, 21)63 (162, 17)56.6 (106, 28)Media engagements173.4 (301, 84)44.8 (109, 9)71.6 (301, 9)38.5 (96, 1)20.9 (57, 8)Likes27.8 (42, 11)12.8 (25, 4)16 (42, 4)11.9 (23, 5)12.7 (24, 5)Expands21.8 (34, 7)11 (43, 1)13.6 (43, 1)13.6 (35, 2)9.8 (44, 1)Retweets17.2 (25, 1)7.2 (14, 2)9.3 (25, 1)7.6 (23, 2)8.3 (16, 4)Max, maximum; min, minimum; VA, visual abstract.Source: Twitter analytics. Analysis done for the following time frame: April 11, 12:00 am to April 17, 10:59 pm. Open table in a new tab Max, maximum; min, minimum; VA, visual abstract. Source: Twitter analytics. Analysis done for the following time frame: April 11, 12:00 am to April 17, 10:59 pm. As the on-site team extensively covered the WCN 2019 scientific content on Twitter, a select group of offsite members chose the most informative evidence-based tweets of the day and packaged them into an interactive online quiz with links to the original tweet. The interactive online quizzes were untimed, multiple-choice questions (with 4 choices) with links to the original tweet (Supplementary Table S2). They were prepared on the https://outgrow.co/ platform and shared across Twitter, Facebook, and select WhatsApp groups for wider dissemination. The responses were followed by an explanation of the correct answer with the link to evidence. Each participant got to know the score and global rank in real time at the end of each quiz. Overall, 4 quizzes covering each day of WCN2019 received 545 page-views and 260 completed attempts by May 25, 2020 (Supplementary Table S3). Approximately 119 of the total 260 quiz attempts were made during the conference dates (April 11–15, 2019) and the rest thereafter. They garnered participation from across the globe (Asia: 51.3%, Europe: 18.5%, America: 11%, Oceania: 8.5%, Africa: 4.6%, and unknown: 6%). Most (63.9%) participants completed the quiz on mobile devices, underscoring the ease of accessibility. Out of the 48 participants who completed a google form-based anonymous feedback survey (Supplementary Table S3) on the quizzes, 96% found the references helpful and affirmed that their knowledge improved and 92% supported this as an effective social media learning tool. There were 70.8% who completed the quiz in less than 15 minutes, 81.3% graded the difficulty level as optimum, and 71% preferred the 10-question format. Apart from the advantages of being free, repeatedly usable, unrestricted by time and location, and requiring minimum time, they also could be repeatedly attempted after the conference was over. They also facilitated more organic participation and active learning from the conference among the audience far and beyond. On-site physical posters are the mainstay of original research presentations in scientific conferences but limited by time and access among the conference attendees with indeterminate reach. In WCN2019, the social media team introduced "poster talks," where preselected posters were described with the accompanying visual of the poster as a video clip of ≤140 seconds' duration and shared in social media during the conference. Recorded using handheld mobile phones and tablets with some use of accessory microphones, there were minimal issues in recording these talks. Despite short notice and no special "preparation," most of the speakers were at ease during these talks, as it closely reflected the face-face poster presentation. In addition, periscope videos of "poster interviews" of participants presenting their research at the conference venue were shared as multimedia tweets. They enable the direct representation of researchers in the wider dissemination of research beyond the limits of the congress. These initiatives garnered widespread interest in social media (Table 1). Besides poster interviews, some interesting videos, such as speaker interviews, were uploaded on to the ISN YouTube account and shared on Twitter, Facebook, and select WhatsApp groups. There were 8 such videos that garnered a total watch time of 1650 minutes with 5780 impressions and 960 unique views. There is quite limited coverage of conference content in alternative #SoMe platforms, such as Facebook, Instagram, and YouTube. The popularity of these alternative SoMe platforms vary globally, with Facebook being more commonly used in regions such as Asia (personal communication, Dr. Sanjay Srinivas, Convenor Nephrology Association of Karnataka, Bangalore, India). The ISNSoMe team also used Facebook and YouTube for coverage of WCN2019. The ISN has an active Facebook profile with free content, in addition to a private Facebook ISN Education group that had 1089 professional members from more than 100 countries at the time of the WCN2019. According to Facebook (and its subsidiary Instagram) analytics, a total of 180 posts from WCN2019 featured with #ISNWCN were accessed by 509 members from 45 countries with 357 reactions. Gathering 340,000 unique impressions and 50 mentions (Facebook: 13; Instagram: 37), the posts generated 1786 interactions (1720 likes, 36 comments, and 30 shares) and had overall positive engagement (87% sentiment analysis). Similarly, videos such as speaker interviews were uploaded onto the ISN YouTube account and shared on Twitter, Facebook, and WhatsApp. The 8 videos by @ISNWCN garnered a total watch time of 1650 minutes with 5780 impressions and 960 unique views. These data suggest that it is possible to reach a wider global audience with use of variably relevant social media platforms. A comparison of social media coverage metrics of WCN2019 with WCN2017 and other contemporary international nephrology conferences preceding WCN 2019 showed not only an increased social media activity in terms of percentage of retweets, evidence-based tweets, video recordings, and active participants (Supplementary Table S1), but also extensive dissemination that reached out to a large number of participants all over the world. The interesting strategies, many afresh in nephrology conference coverage, add to the popular content (such as the CREDENCE trial presentation coverage) to help improve the reach of WCN2019 social media coverage. Social media–based strategy limits time, travel, expenditure incurred with physical attendance of conferences, and enables a wider global audience, including those who may not be in a position to attend such conferences for various reasons. Our results demonstrate the successful use of social media strategies like VAs (prepared and live-created), online quizzes, poster talks, and poster interviews providing a synopsis of the vast information presented in the conference in an easily comprehensible form that is instantly accessible at minimal cost, enhanced the extensive global reach of WCN 2019 social media coverage. Using multiple platforms like Twitter, YouTube, Facebook, and Instagram not only boosted social media participation of nephrologists but also promoted wider global interaction on the conference content. Despite the several advantages, virtual coverage cannot replicate the unique advantage of having in-person interactions and face-to-face networking. In addition, despite the academic content and natural peer review, social media–based education has not yet gained widespread acceptance among traditional academia as a form of scientific communication. The members of the social media team can help cohesively disseminate scientific conference content worldwide early on. There is, however, a small risk of potential alienation from conference attendees who are not part of this initiative or of a competing initative with another society or group. Care must be taken by all such groups to democratize the use of social media to make it more inclusive. The novel strategies have some limitations: (i) The skills required for creating them required a flair for both the scientific content as well as the content-processing and social media tools not shared by everyone; and (ii) the act of real-time creation of social media content such as live visual abstracts, could divide the attention of the creator and potentially impact its clarity. Although many interesting strategies have contributed to the improvement in quantity and quality of engagement with social media–based conference coverage, It is not possible that there is some underlying impact of the popularity of content over the strategy, as well as the impact of temporal rise in social media uptake by the global academic community contributing to the increasing numbers. Finally, the current measures of numerical engagement metrics are less illustrative of the actual academic impact of the content and call for novel indices of the impact of social media–based education and the ensuing collaborations to provide due academic credit. The ISN, with an international team of nephrology social media professionals actively promotes social media coverage, networking and worldwide dissemination of content from the WCN, across Twitter, Facebook, and YouTube to promote nephrology education across the global nephrology community, enhancing this initiative by strategies such as "poster talks," "poster interviews," online quizzes, and live visual abstracts.

INTRODUCTION:Patient experience is positively associated with clinical effectiveness, self-rated and objectively measured health outcomes, patient activation and treatment adherence.Furthermore, insight into people's experience is crucial in shaping services and providing responsive and person centred care.The Renal Association and Kidney Care UK's Kidney Patient Reported Experience Measure (KPREM) was co-designed by patients, academics and clinicians in 2016 to give patients the opportunity to feed into service improvement by sharing what matters to them.It was piloted and validated in 2016-2017 and subsequently rolled out across the UK.This abstract reports the results from the 2017 and 2018 KPREM.METHODS: The 2018 KPREM consists of 39 items across 13 domains covering patient experience of their renal unit, kidney disease and treatment.There are six demographic questions including age, sex, ethnicity and modality.The KPREM was distributed to all UK renal units in June 2018, with accompanying survey guidance and support provided to invite outpatient, pre-dialysis, dialysis and transplant renal patients to complete the KPREM online or in hard copy format.It was provided online in Welsh, Gujarati and Urdu as well as in English and patients participated anonymously, returning hard copy KPREMs to their unit in return boxes or directly to the UK Renal Registry by post.Experience was scored on a scale of 1 (negative) to 7 (positive).Analysis was conducted at individual unit and aggregate centre level (aggregate being the main hospital and all of its satellite units).Unit and centre means were estimated across respondents for that unit or centre.Patient characteristics were evaluated by comparing mean scores, and via regression models.RESULTS: 13,770 analysable responses were received in 2018 from 71 out of 72 adult renal centres, incorporating 281 units in total.The findings from 2017 and 2018 validated KPREM collections show a remarkably similar national picture; evidence of the robustness of KPREM as a measure and therefore a solid baseline for informing and measuring quality improvement.Patient experience was high (6.3 out of 7 in both 2017 and 2018) but with significant variation between centres.Despite considerable shuffling between centre level results, as in 2017, the lowest scoring themes remain Sharing Decisions About Your Care (5.5 out of 7.0 in 2017 and 5.4 out of 7.0 in 2018), Transport (5.6 out of 7.0 in 2017 and 2018) and Needling (5.7 out of 7.0 in 2017 and 2018).Nationally, there has been no improvement in these three key areas, which continue to report the highest variation in scores between centres.Patient characteristics contributed little to variation in both years; only differences smaller than 10% (.7) of the scale range were seen (men and women, age, type or location of treatment, and ethnicity).As in 2017, differences between centres are more important to patient experience than any other difference captured by the KPREM.CONCLUSIONS: Centre and patient participation in the Kidney PREM has increased every year since the pilot in 2016.In both 2017 and 2018 the biggest factor driving variation in patient experience is the treating centre, and not patient characteristics.The consistent and unchanged national findings provide a strong case for change, and a call to action from kidney patients in the UK to address as a priority the three aspects of kidney care that impact most negatively on their experience: Sharing Decisions About Your Care; Transport and Needling.

Pyrethroids are widely used as commercial and domestic insecticides due to their high effectiveness and low toxicity in humans and in medicine for the topical treatment of scabies and head lice. Prallethrin is a structural derivative of naturally occurring pyrethrin and active ingredient in liquid mosquito repellents. Acute human poisoning from exposure or ingestion of pyrethroids is rare because of poor dermal absorption and rapid metabolism with little tissue accumulation. Here we present a case of accidental Prallethrin poisoning(“ALL –OUT”, a liquid mosquito repellent) in a five year old child who had immediate complication as hypovolemic shock with aspiration pneumonia and delayed complications like acute kidney injury, with elevated liver enzymes, requiring renal replacement therapy and had an uneventful recovery.

It is well known that patients with mechanical heart valves may develop sheer stress related hemolysis and consequent pigment related nephropathy. Warfarin Related Nephropathy (WRN) is a relatively new entity and defined as Acute Kidney Injury (AKI) in the setting of an INR of > 3.0 excluding other obvious etiologies. A biopsy diagnosis of WRN is conducted when red blood cell casts are noted filling and blocking the tubules; additionally, glomerular hemorrhage may be observed. We describe a patient with mechanical heart valves on oral anticoagulation who developed both pigment nephropathy and WRN causing AKI.

INTRODUCTION AND AIMS: Decision Making Tools (DMTs) use is nowadays considered as the most accurate method to avoid patients bias to choice and to facilitate an optimal information process.Objectives: To analyze the impact of a structured modality information program with the use of DMTs on type of renal replacement therapy (RRT) choice and start.METHODS: Observational, prospective, open and international registry.All predialysis patients (pts) with CKD G4-G5 and pts after an unplanned dialysis start (if noninformed before) were recruited to undergo a DMTs process for RRT choice.Process included: personal values evaluation, RRT information with different tools, staff deliberation support and patient s modality election.Results are shown as the percentage of pts who reached a certain stage related to the total number of pts under evaluation RESULTS: 1934 pts (mean age 61 y.) from 49 clinics (cl.) in Poland (PL, 19 cl.), Romania (RO, 12 cl.),Hungary (HU, 10 cl.), Germany (DE, 7 cl.) and Argentina (AR, 1 cl.) aimed modality information through DMTs from Aug 2014 to June 2017.Staff considered PD as contraindicated in 29% of total pts, hence optimal candidates for HD/PD were 1377 pts.(mean age 60y.and 44% prone for a home therapy).Early referral (3 m. in clinic before process started): 52%.Different aids were used: written information (97% of pts), DVD in 19-37% (except AR, 3%) and HD/PD utility visits in 40-76% (except DE, 16%).Relatives' participation in the process was 82% (45-90% by countries).Most pts (93%) considered the program as useful.PD choice (33%) varied among countries: 12% (RO), 28% (PL), 37% (HU), 66% (DE) and 94% (AR).For pts who already started dialysis (n¼781), PD as chronic RRT was 29% (8% after an unplanned HD start); 9% (RO), 27% (PL), 35% (HU), 55% (GE) and 88% (AR).CONCLUSIONS: Use of DMTs at the time of RRT modality choice complies with patient empowerment.Impact on PD take-on varied among countries.One third of the suitable patients for both dialysis modalities were ascribed to PD. Modality information should always be delivered through a structured information process based on decision sharing (patients-relatives-staff).